Exercise Prescription for CR & PR (Part 1) Flashcards
Why do we assess exercise capacity?
- Level of functional impairment & activity limitation
- Limiting factors of exercise capacity
- Guide exercise prescription
- Identify O2 desaturation & need for supplemental O2
- Evaluate effectiveness of rehab
What are the goals of exercise in PR & CR?
- Improve exercise capacity & functional ability
- Decrease symptoms
- Empower self-mnitoring, management of symptoms & confidence to exercise
- Find a safe & effective dose of exercise
- Return to work or functional independence
- Improve QOL
What is the overall benefit of exercise?
Increase CR fitness, decrease risk factors & symptoms
What is the main contributor to an increase in CR fitness in cardiac & pulmonary patients?
Peripheral adaptations (muscle)
How would you address a high risk patient in a group exercise class?
- Decrease intensity
- Monitor closely
- Increase staff
- Group high risk patients together
- Decrease class size
- Ensure equipment is nearby (crash cart, O2 etc)
What are some of the other CIs of exercise?
- Uncontrolled/poorly controlled asthma
- Unstable/uncontrolled COPD
- Unstable cancer/blood disorders
- Uncontrolled diabetes
- Osteoporosis/high fracture risk
- Unexplained symptoms that could cause risk of injury or exacerbation
What are the safety considerations in CVD patients?
- Exclude high-risk patients from vigorous activity
- Screen high-risk patients prior to exercise
- Stop exercise & promptly evaluate/refer if any symptoms (chest pain, dizziness, arm/jaw pain, severe SOB, irregular HR, excessive fatigue)
What are the exercise considerations for clinicians in COPD?
- Stratify patients according to need for medical support
- Work closely with PR teams
- Encourage patients to discuss daily exercise plans with their doctor
- Reassure patients that mild SOB is normal
- Ensure they do a warm-up & cool-down
- Aerobic training for major muscle groups of lower limb
- Incorporate endurance & strength training for upper limbs
- Consider interval training
What are the exercise considerations for patients in COPD?
- If SOB, aim to slow down rather than stop
- If persistent severe SOB, stop & rest or take a reliever inhaler
- Always notify someone if exercising in a group/gym
- Stop exercise if feeling nausea, dizziness, headache, pain in chest/neck/jaw
- Start rehab early
What are the exercise considerations in CVD?
- High intensity = higher risk
- Warm-up/cool-down
- ICDs have 10-30s delay between arrhythmia & shock
- Avoid dehydration
- Stroke patients 3 times more likely to fall/suffer hip fractures
What is the BGL CI for diabetes?
BGL outside 6-10mmol
What are the precautions for hyper/hypoglycaemia?
- Check BGLs 2 x before & after exercise
- Keep carb sources handy
- Exercise 1-2 hrs after meal & >1 hr after insulin injection
- Don’t exercise if BGL > 13-15mmol
- If <6mmol take carb source
What is a precaution for exercise in kidney disease?
High BP can aggravate disease progression
What are the precautions for exercise in peripheral neuropathy?
- Avoid high intensity exercise
- Problems managing temperature control
- Safe area with weights
- Grip may be impaired so be careful with weights
What is the most important exercise advice for T2 diabetes?
Check feet before and after exercise & at least twice daily
What does a PA history consist of?
- Current PA/exercise
- PA levels before/since exacerbation
- Intention to do PA/exercise (stage of change)
- Past PA/exercise & preferences
- Current symptoms & past medical history
What are the stages of change?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance (>6 months)
- Relapse
What is the principle for exercise prescription?
FITTVE:
- Frequency
- Intensity
- Time
- Type
- Volume
- Progression
What is the normal prescription for CR & PR?
- Twice a week
- Low-mod intensity
- 1 hour
- 4-12 weeks (8-12 weeks heart failure)
- Individually tailored
What should the warm-up include?
- 10-15 mins
- Low-impac, dynamic movements
- Large muscle groups
- AROM all major joints
- Gradually increase size & ROMs
- RPE 3
What is the recommended intensity for aerobic exercise?
- Moderate (40-60%) to vigorous (60-90%)
- Light (30-40%) to moderate in deconditioned adults
What are the prescription guidelines for aerobic exercise for PR & CR patients?
F: 3-5 days per week I: 40-80% intensity, 80% 6MWT, 4-6 Borg T: 20-60 mins T: Rhythmic large muscle group activities V: Interval, continuous P: No standard format
What is a good exercise strategy for reducing SOB in pulmonary patients?
Fixing the shoulder girdle, e.g. walking aid, stationary bike
What are the prescription guidelines for aerobic exercise for PR & CR patients?
F: 2-3 days/weel
I: 3-5 Borg, 30-40% upper body, 50-60% lower body
T: 48hrs between sessions
T: Various equipment
V: 10-15 reps, 1-3 sets
P: Increase resistance/weight, reps, decease rest
